New guidelines for coronavirus patients: When to stay home, when to seek treatment and which | Skai.gr

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THE Hellenic Society of Infections recently revised) the treatment algorithm of adult non-hospitalized patients with COVID-19. The Doctors of the Therapeutic Clinic of the Medical School of the National and Kapodistrian University of Athens, Theodora Psaltopoulou, Giannis Danasis, Panos Malandrakis and Thanos Dimopoulos (Rector of EKPA) summarize the instructions.

The outpatient management of the COVID-19 patient with mild to moderate disease (oxygen saturation> 94% in room air) depends on the presence of risk factors for severe disease.

Risk factors for severe disease include the following: non-vaccination, age> 70, obesity (BMI> 35), immunosuppression, dialysis, chronic heart disease, COPD, diabetes, and hemoglobinopathies.

Signs and symptoms that indicate severe COVID-19 disease and a possible need for hospitalization include the following: oxygen saturation <90% in room air (or 30 breaths / minute, use of adjuvant respiratory muscles, inability to deliver complete sentences) and / or extensive filtration (> 50%) on chest imaging and / or combination of laboratory (lymphocytes) 1000 mg / ml, CRP> 100 mg / ml with normal value <5).

Case 1: Outpatient with mild to moderate disease (oxygen saturation> 94% in room air), who has no risk factors for severe disease

• No special medication is given
• The patient monitors his temperature and oxygen saturation with an oximeter at least twice a day.
• Good hydration, antipyretics and bed rest are recommended until the fever completely subsides.
• Antibiotics are given only on clinical, imaging or laboratory evidence of bacterial pneumonia infection

Case 2: Outpatient with mild to moderate disease (oxygen saturation> 94% in room air), who has risk factors for severe disease

• No special medication is given
• The patient monitors his temperature and oxygen saturation with an oximeter at least twice a day.
• Good hydration, antipyretics and bed rest are recommended until the fever completely subsides.
• Antibiotics are given only on clinical, imaging or laboratory evidence of bacterial pneumonia infection

Early treatment in patients who do not need hospitalization for mild to moderate disease to avoid progression to severe disease

• Inhaled Budesonide (Not approved by Coreper at present)
• Molnupiravir orally (Not approved by Coreper at present)
• Monoclonal antibodies (when available):

In the first 5 days after the onset of symptoms or test positive (antigenic or molecular) one of the following monoclonal antibodies is administered:

    Casirivimab/imdevimab
 Bamlanivimab / etesevimab
 Sotrovimab

Finally, it should be noted that regardless of the presence of risk factors, the use of the following drugs is not recommended in outpatients with mild to moderate COVID-19 disease, unless there is evidence other than COVID-19: corticosteroids such as dexamethasone, colchicine , ivermectin, (hydroxy) chloroquine, heparin or anticoagulants, antibiotics such as azithromycin, clarithromycin or quinolones.

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